Abstract: TH-OR002

Racial Disparities in Coronary Artery Bypass Graft Surgery in Maintenance Dialysis Patients

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Norris, Keith C., David Geffen School of Medicine at UCLA, Los Angeles, California, United States
  • Yuan, Christina M., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Agodoa, Lawrence, National Institutes of Health, Bethesda, Maryland, United States
  • Abbott, Kevin C., National Institutes of Health, Bethesda, Maryland, United States
Background

Racial disparities in invasive cardiac procedures such as coronary artery bypass graft (CABG) in the general population are well documented. However, contemporary national-level data on such disparities in the end-stage renal disease (ESRD) population are lacking. Herein we assessed racial differences in the receipt of CABG between Blacks and Whites with ESRD, after the start of maintenance dialysis.

Methods

Using the US Renal Data System database, we identified 281,464 Medicare primary patients initiated on maintenance dialysis from 1 January 2009 through 1 June 2013, and followed until 31 December 2013. We abstracted Medicare hospital claims for CABG among patients who had primary diagnoses of either native coronary atherosclerosis (NCA) or acute myocardial infarction (AMI). We conducted logistic regression analyses, adjusted for demographic characteristics, Hispanic ethnicity, cause of ESRD, comorbidities, socioeconomic factors (insurance type to include Medicare-Medicaid dual eligibility as a proxy measure of individual-level poverty, employment status, and ZIP code-level median household income [MHI] obtained from the 2010 US Census).

Results

8,004 patients underwent CABG surgery during the study period, of whom 19.4% were Blacks and 74.6% were Whites. Fully adjusted models demonstrated that, among patients with primary diagnoses of NCA or AMI, Blacks were significantly less likely to undergo CABG compared to Whites (odds ratio [OR] 0.76, 95% CI 0.64-0.90, p=0.002). The odds were similar in non-Hispanic Blacks vs. non-Hispanic Whites (OR 0.74, 95% CI 0.62-0.88, p=0.001). There were no significant interactions between race and ZIP code-level MHI (p=0.31), or dual-eligibility status (p=0.60).

Conclusion

Similar to the general population, there exists a racial gap among incident dialysis patients undergoing CABG surgery despite having comprehensive coverage with Medicare. These findings persisted despite accounting for demographic, clinical and socioeconomic factors.

Disclaimer: The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of the Army/Navy/Air Force, the Department of Defense, National Institutes of Health, or the United States government.